Thirteen years ago today, President Barack Obama and Democrats in Congress fundamentally transformed the U.S. health care system by providing health insurance coverage that curbed costs and expanded access to millions of Americans. While challenges remain to strengthen the legislation, the Affordable Care Act (ACA) remains entrenched as a permanent feature of America’s hybrid, public-private health care system, and continues to deliver on its promise to provide near-universal coverage to Americans at an affordable cost.
Since its enactment, the Republican Party has unleashed relentless attacks and legal challenges to health insurance coverage while repeatedly trying to repeal and replace the ACA despite widespread and growing support for the legislation. While Republicans tirelessly work to cut insurance coverage and raise health care costs for families across the United States, the ACA continues to serve as a milestone in the Democratic Party’s century-long struggle to create a universal health care system that leaves no one out.
As we look back on the successes and challenges of the Affordable Care Act, the Progressive Policy Institute (PPI) is marking the anniversary by releasing a policy brief examining the high-level benefits of the legislation’s implementation and additional policy solutions to bolster the law. The policy brief is titled “A Public Policy Success: The Affordable Care Act and the Road Ahead,” and is authored by PPI’s Director of Health Care Erin Delaney.
In tandem with the policy brief, Delaney sat down with former Health and Human Services Secretary Kathleen Sebelius to reflect on the landmark passage of the ACA and the critical role it played in providing essential coverage to millions of Americans during the COVID-19 pandemic. In a new interview, Delaney and Secretary Sebelius look back on the path — 13 years ago — that led to one of the most consequential pieces of health care legislation to be enacted in this country.
Download the policy brief here and listen to the full podcast episode here.
The Progressive Policy Institute (PPI) is a catalyst for policy innovation and political reform based in Washington, D.C. Its mission is to create radically pragmatic ideas for moving America beyond ideological and partisan deadlock. Learn more about PPI by visiting progressivepolicy.org. Find an expert at PPI and follow us on twitter.
The Patient Protection and Affordable Care Act (ACA), signed into law by President Barack Obama in 2010, transformed the way the U.S. health care system provides health insurance coverage that curbed health care costs and modified how health care is delivered. On the 13th anniversary of the law, it’s clear that it advanced America closer toward universal coverage, but challenges remain. As lawmakers and key stakeholders address these systemic issues that contribute to more expensive, less accessible health care, it is critical that they focus on building on the law by prioritizing Medicaid expansion in non-expansion states, mitigating coverage loss from the unwinding of the public health emergency (PHE) declaration, ensuring the U.S. has the resources needed to respond to ongoing COVID-19 costs and future pandemics, boosting funding and state data infrastructure to strengthen efforts to address social determinants of health, and expanding postpartum Medicaid coverage.
The ACA has faced an obstacle-strewn path with countless legal and legislative challenges throughout the past 13 years. Only one House Republican voted for the ACA’s passage in 2010. Republicans have since been waging an implacable battle to repeal “Obamacare,” which they touted would undermine private insurance markets and raise premiums. Nearly every budget or fiscal plan of theirs since the law’s enactment has included repealing the ACA as well as cutting Medicaid. After President Donald Trump’s election, Republicans tried repeatedly to repeal and replace the ACA but failed, despite controlling both chambers of Congress. In a dramatic 2017 vote, Republicans fell one vote short of repealing the law. In the 2018 midterm elections, they lost control of the House in a Democratic sweep, attributed in part to growing public support for the ACA.
Simultaneously, the ACA has been subjected to more than 2,000 legal challenges since its implementation. The most recent notable case, California v. Texas, which was heard by the Supreme Court in June 2021, claimed that the lawsuit filed by Texas lacked standing. The Texas district court asserted that the reduction of the individual mandate in the 2017 Tax Cuts and Jobs Act to zero was justification for the ACA’s unconstitutionality as an improper use of Congress’s taxation powers. Legal experts, even those opposed to the ACA, agreed that the legal arguments to this case were absurd, as Texas ignored Congress’s decision to zero out the individual mandate but to leave the rest of the ACA in place, which is principally Congress’s decision, not the court.
Despite the at least 70 Republican attempts to repeal or modify the ACA, the law seems firmly entrenched as a permanent feature of America’s hybrid, public-private health care system. It has delivered on its promise to increase coverage and access for millions of Americans and played a key role in helping people who lost job-based insurance stay covered throughout the COVID-19 pandemic. The law also has been a milestone in the Democratic Party’s century-long struggle to create a universal health care system that leaves no one out. It’s brought our country very close to universal coverage, while also testing new ways to deliver health care and reduce its cost.
This policy brief will examine the benefits of the implementation of the ACA, how to build on the ACA’s accomplishments, and rein in high medical costs to improve community health.
By Dr. Robert Popovian, Senior Health-Policy Fellow for PPI;
and Catherine Barr Windels
For decades, lobbyists for the pharmacy-benefit-management (PBM) industry have been telling policy-makers, employers, and patients that PBMs (middlemen responsible for the administration of the prescription-drug benefit for various health-plan payers) save everyone money. They argue that opaque negotiation, rebate contracting, and vertical and horizontal integration are intended to help lower biopharmaceutical spending. Unfortunately, the promises of savings are a mirage, with no data-driven analysis to back them up. The PBM industry is thus staunchly opposed to laws that provide transparency into their business practices.
Fortunately, states and federal legislators are finally taking action. They have decided to scrutinize the flow of untold billions of dollars in discounts, fees, concessions, and rebates that are siphoned off from the biopharmaceutical industry by the pharmacy-benefit managers. The estimated total collected by the middlemen is over $200 billion annually, which makes up almost 40 percent of drug spending in the U.S. Unfortunately, because of a lack of transparency, no one, including federal and state governments, has a clue as to how much of that money provided by the pharmaceutical industry is kept by PBMs. At best, there are estimates by various governmental agencies of the amount of savings that is passed back to those who are supposed to benefit from the work of PBMs: the employers, the state and federal governments, and most importantly, the patients. It is important to note that such estimates are primarily based on modeling data, testimony by PBM officials, or incomplete information.
As the country continues to grapple with the consequences of the reversal of Roe v. Wade, the landmark Supreme Court case that guaranteed the constitutional right to an abortion for nearly half a century, it is critical for President Biden to reassure all Americans who can get pregnant that his administration will continue to work to restore abortion rights. President Biden needs to respond to Republicans doubling down on restricting and outlawing access to abortion as they ramp up their campaigns for the 2024 election by further expanding access to medication abortion drugs, including Mifepristone. The Biden administration should eliminate the pharmacy and prescriber certification requirements to dispense mifepristone, and assert the authority of the FDA to preempt state law for FDA-approved medications to prohibit states from banning access to medication abortion.
Now that the Biden administration has announced that the Public Health Emergency (PHE) declaration will end on May 11, President Biden needs to reassure Americans that the transition will not affect their access to coverage and affordable care. The PHE declaration that was issued by the Secretary of Health and Human Services in March 2020 provides flexibilities for the federal government to modify or waive certain requirements, including for Medicare, Medicaid, and the Children’s Health Insurance Program. Those who are vulnerable — children and those with chronic illnesses and disabilities — will need more assistance in navigating the administrative process to regain coverage once the PHE declaration ends. President Biden should call for relaxing eligibility requirements that were exclusionary before the PHE declaration was issued by reducing administrative burdens using administrative data and targeting assistance to those groups to keep eligible individuals and families enrolled.
Additionally, various provisions that were authorized by the Public Readiness and Emergency Preparedness (PREP) Act into the COVID-19 PHE declaration are set to expire next year. These provisions permitted pharmacists and pharmacy technicians to administer COVID-19, flu, and all recommended pediatric vaccines without a prescriber order, even in certain states that have laws that limit pharmacies from administering some vaccines to certain populations. If these provisions expire, 25 states where the authority for pharmacist-administered vaccines has not been made permanent will face the consequences of the expiration most acutely as states will return to restricting pharmacists to administer certain vaccines, including the COVID-19 vaccine. President Biden should call on states to adopt and codify the PREP Act declaration expanding pharmacist ability to vaccinate in state law, which governs pharmacist practice, to ensure Americans continue to have greater access to these life-saving vaccines beyond the end of the PHE.
This post is part of a series from PPI’s policy experts ahead of President Biden’s State of the Union address. Read more here.
The future of Social Security and Medicare has unexpectedly become a central point of contention in the final week before the 2022 midterm elections. As the two biggest non-emergency spending programs in the federal budget and the foundation of retirement security for nearly all American workers, it makes perfect sense to have a conversation about Social Security and Medicare during election season – particularly since both programs face serious financial challenges as our population ages. Unfortunately, the debate currently playing out on the campaign trail is devoid of the serious substance voters deserve, and it’s abundantly clear that neither party has a good plan to secure these programs for current and future beneficiaries.
Sen. Rick Scott (R-Fla.), who leads the GOP’s Senate campaign arm, kicked off the discourse when he released a proposal that would allow all federal programs – including Social Security and Medicare – to expire if not reauthorized every five years. Sen. Ron Johnson (R-Wis.), a far-right senator who is up for re-election next week, then suggested requiring the programs be reauthorized annually. Such a radical change that would enable these essential programs to suddenly vanish every few years would be catastrophic for American workers, who must plan their retirements around them years or even decades in advance.
President Biden and lawmakers in both parties have prioritized slashing Americans’ out-of-pocket spending on insulin. And they recently made significant strides by including a $35-a-month co-pay cap for insulin for Medicare beneficiaries in the Inflation Reduction Act.
But as promising as these cost reduction measures are, they raise a key question: Why limit the co-pay price caps to just insulin?
More than 6 million North Carolinians live with at least one chronic condition, and 2.5 million are living with two or more. For seniors on Medicare, chronic disease prevalence is even higher, and for millions with fixed incomes, out-of-pocket costs are increasingly problematic.
If a $35-a-month co-pay cap makes sense for insulin — and it does — why not implement the same policies for medicines that treat asthma, hypertension and other common chronic conditions and focus on Medicare where chronic diseases are so prevalent?
Superbugs: The Coming Global Crisis to our Public and Economic Health
Wednesday, September 21, 2022
2:00 p.m. — 3:00 p.m.
Zoom Webinar
About this event
Join public health experts and economists for a conversation on the coming global crisis: antimicrobial germs, or ‘superbugs’.
The Progressive Policy Institute (PPI) recently published a new report, titled “The World Needs Better Incentives to Combat Superbugs” which called for swift action on this growing crisis. As outlined in their new report, antimicrobial resistant germs are killing tens of thousands of Americans annually, and the problem is only getting worse in the post-COVID age.
Hear from leading experts about the health and economic costs of the crisis, and the policy actions needed now.
Panelists: Amanda Jezek, Senior Vice President for Public Policy and Government Relations at the Infectious Diseases Society of America (IDSA) Dr. Robert Popovian, PPI Senior Fellow for Health Policy (Moderator) Dr. Michael Mandel, PPI’s Chief Economist
The Progressive Policy Institute (PPI) released a new report today calling for action from U.S. policymakers on the global “superbug” crisis. Antimicrobial resistant germs are killing tens of thousands of Americans annually, and the problem is only getting worse in the post-COVID age. The paper is titled, “The World Needs Better Incentives to Combat Superbugs”and is co-authored by Arielle Kane, Director of Health Care at the Progressive Policy Institute and Dr. Michael Mandel, Vice President and Chief Economist at the Progressive Policy Institute.
“Without changing how we use and develop new antimicrobials, millions more people will die, and health advances will be lost,” the co-authors write in the report.
Ms. Kane and Dr. Mandel outline a troubling public health trend that has far-reaching implications – including global economic stressors. The report authors note that roughly 35,000 Americans are killed annually by germs resistant to antimicrobials, or medicines like antibiotics and antifungals that are used to treat infections. These infections are on the rise, and without policy intervention, could kill 12 million people annually worldwide by 2050.
This crisis extends beyond a public health crisis – it is also putting the global economy at risk. According to a World Bank study, these infections could also reduce global GDP by 2%-3.5% by 2050.
The authors call for three methods in combating superbugs and the continuation of this trend, including curtailing the overuse of antimicrobials in medicine, limiting the use of antimicrobials on animals and agriculture; and new incentives to invest in the development of new antimicrobials.
The Progressive Policy Institute (PPI) is a catalyst for policy innovation and political reform based in Washington, D.C. Its mission is to create radically pragmatic ideas for moving America beyond ideological and partisan deadlock. Learn more about PPI by visiting progressivepolicy.org.
Germs resistant to treatments kill roughly 35,000 Americans per year. Infections caused by drug-resistant bacteria, viruses, and fungi are on the rise, and without changes in policy, could kill 12 million people annually worldwide by 2050. Drug-resistant infections could reduce global GDP by 2%-3.5% by 2050, according to the World Bank.
The overuse of antibiotics and poor infection control during the height of the COVID-19 pandemic may have exacerbated antimicrobial resistance (AMR). AMR occurs when bacteria, viruses, fungi, and parasites evolve to no longer respond to treatments or when new pathogens that resist treatment emerge. Often referred to as “superbugs,” they pose the risk of severe illness or death.
If science doesn’t stay ahead of AMR, health care will slide backwards to the days when diseases now considered treatable — pneumonia and skin staph aureus infections — killed thousands of people each year. Yet today we’re seeing the spread of deadly strains of bacteria that can cause blood infections, pneumonia, and sepsis. That’s why the World Health Organization says that antimicrobial resistance is one of the top 10 global public health challenges threatening the practice of modern medicine.
The U.S. needs to combat these superbugs on three fronts:
• Curtailing the overuse of antimicrobials in medicine,
• Limiting the use of antimicrobials on animals and agriculture, and
• Investing in the development of new antimicrobials to stay ahead of nature.
BACKGROUND
Prior to the discovery of penicillin in 1928, diseases such as pneumonia, skin infections, meningitis, and whooping cough were often fatal. But once the use of antibiotics became mainstream in the 1940s, these infections became minor, easily treatable illnesses that no longer warranted a death sentence. The average life expectancy was extended by roughly 20 years because of the widespread use of antibiotics. But almost immediately, scientists discovered that certain types of bacteria were becoming resistant to penicillin and began working on second-generation antibiotics.
Unfortunately, scientific discovery hasn’t kept pace with evolutionary biology — both because superbugs evolve to evade antimicrobials and because new superbugs are also being discovered in the far reaches of the globe.
Without changes in scientific discovery and policy, AMR poses a risk to society and modern medicine. While pathogens are evolving to evade our current arsenal of drugs, scientific investment isn’t keeping pace in development of new antimicrobials. When COVID-19 emerged, the response was to invest in antivirals and there were roughly 260 COVID-19 antivirals in clinical development in 2020-2021. By contrast, there are only 73 new antimicrobials in clinical development because of poor incentives and a lack of investment.
PROBLEM STATEMENT
According to a recent study published in The Lancet, in 2019, 1.2 million people died directly from drug-resistant infections while AMR contributed to the deaths of 5 million additional people worldwide. This means that an infection may have exacerbated existing medical conditions and contributed to death rather than being the only causal factor.
Then came the COVID-19 pandemic. The Centers for Disease Control and Prevention (CDC) data show that resistant hospital-onset infections and deaths increased at least 15% during the first year of the pandemic. This could be because of an increase in hospital-acquired infection as more people were hospitalized, or because infection control languished as hospital staff were over-burdened with COVID-19 or because antibiotics were overused as people presented with ambiguous respiratory symptoms. But the fact remains that without changing how we use and develop new antimicrobials, millions more people will die, and health advances will be lost.
OVERUSE
About 80% of antibiotics used in the United States aren’t used by humans, but by livestock — cows, pigs, and chickens. Many industrial scale farms use antibiotics prophylactically — to prevent disease and to accelerate growth — which contributes to drug resistant pathogens living in the food and water supply. The European Union has recently banned prophylactic antibiotic use in livestock, but the U.S. and other countries don’t limit how farmers can use antibiotics.
But the overuse doesn’t stop there. In 2019, farmers under attack from a bacterial infection that threatened to decimate Florida citrus groves received permission from the Trump administration to use controversial bactericides on their trees. The Environmental Protection Agency allowed farmers across California, Florida, and Texas to use streptomycin and oxytetracycline — drugs typically used for syphilis, tuberculosis, and urinary tract infections — on their citrus plants. Using medical-grade antimicrobials increases the risk that pathogens develop resistance to these treatments in soil, water, and eventually humans.
Finally, antibiotics are overused in the practice of medicine, which is the final key driver of antimicrobial resistance. The CDC reports that 70% of the bacteria that cause two million hospital-acquired infections annually are resistant to at least one antibiotic. Although there were declines in hospital-acquired infections before the onset of the COVID-19 pandemic, hospital infections surged in recent years. This might have been because of increased antibiotics prescribed to prevent secondary lung infections brought on by a COVID hospitalization. Between March and October of 2020, 80% of hospitalized COVID patients were prescribed antibiotics.
While the prescriptions may be medically necessary, increased use contributes to resistance if science can’t stay ahead of AMR. Infection control efforts may have also lapsed under staff shortages and over-burdened hospitals.
Additionally, the CDC estimates that at least 30% of outpatient antibiotic prescriptions are unnecessary, most commonly prescribed for viral respiratory infections, such as viral bronchitis, otitis, and sinusitis. With millions hospitalized for respiratory problems, COVID likely exacerbated the overuse.
Even necessary antimicrobial use contributes to the weakened efficacy of treatments over time. Each time pathogens are exposed to antimicrobials, they have the opportunity to adapt to evade them. But unnecessary use means that patients have no medical need for the drugs, may damage their own health from taking the drugs unnecessarily, and add to the weakening of the drugs over time.
Back in July, federal regulators began requiring that health insurers disclose their prices for the services they cover both in- and out-of-network.
The idea is to help health care consumers better understand what their co-pays and liabilities may be depending on where they go for care.
The rule reveals, but doesn’t solve, a fundamental flaw of the U.S. health care system: widespread price variation.
As an experiment, I used a price estimate tool for OhioHealth, a large health system in Ohio. I typed in “Arthroplasty Hip/Knee Total,” a full knee replacement surgery, and searched the price as an uninsured patient. And within the same health care system, the price varied from $57,297 at Riverside Methodist Hospital to $67,842 at Grant Medical Center.
Earlier this month, a new report showed that the United States reached the lowest uninsured rate ever recorded, according to the Department of Health and Human Services (HHS). This was the result of Democrat persistence of the last decade: the passage of the Affordable Care Act (ACA), the subsequent Medicaid expansions, the additional subsidies for ACA plans passed under Biden, and because throughout the pandemic, people have kept their Medicaid coverage.
In 2009, before the ACA was passed, roughly 50.7 million people, 16.7% of population, were uninsured. Today, despite narrow majorities and Republican opposition, the uninsured rate is half that. Since the passage of the ACA, 38 states and the District of Columbia expanded their Medicaid programs to cover people up to 138% of the federal poverty level. During the pandemic, in exchange for increased funds from the federal government, states were asked not to disenroll people from Medicaid. As a result, more people have received coverage and kept it over the past 2.5 years.
While more people were receiving Medicaid coverage, President Biden and Congress pushed to enhance the subsidies for ACA plans for people in the individual market. The expanded subsidies were recently extended through 2025 by the Inflation Reduction Act, and will save the average enrollee $800 per year. This led to approximately 2 million additional enrollees in ACA plans, increasing it to its highest ever enrollment of 14.5 million people.
But there is evidence that these policies will continue to grow. More states are considering Medicaid expansion: The Supreme Court made Medicaid expansion optional more than a decade ago and the question of expansion has seemed to be stuck in the mud in recent years. But, there is evidence that some of the last holdouts are beginning to warm to the idea as some rural hospitals have struggled to survive. Expanding Medicaid in the 12 non-expansion states would bring health care coverage to 3.7 million people and reduce the already low uninsured rate by a third. The remaining uninsured are largely low-income families, undocumented workers, and people who churn between coverage options.
Lasting change is hard, and in the U.S. our system is designed to make large, systemic change nearly impossible. But when lawmakers can coalesce around a policy, and build on it with time, big transformative change is possible. The ACA started by plugging holes in our current system: it created a marketplace for people who don’t have coverage through work, expanded Medicaid, and tweaked some Medicare programs. In the years since, lawmakers have built on the success of those policies, and today we are seeing the fruits of those efforts.
The work isn’t done: The system still costs far too much and doesn’t deliver high quality results for everyone. But the groundwork has been laid and it’s important to note how far we’ve come.
Digital privacy laws are not ready for a post-Roe v. Wade future. New bills circulating on the Hill are an important step toward safeguarding Americans’ personal data, but they are not a panacea to protect women seeking an abortion or the friends and family members who might be supporting them, or even just know of their intentions.
It’s no secret that today, personal and health data about human preferences, location, characteristics and behavior are collected through phones, apps, websites, advertisements, internet sites and service providers; if a device is connected to the internet, it probably collects user data. These data are used to provide helpful information and services, but as the United States lacks universal digital privacy protections, firms are solely responsible for data privacy and security.
At the same time, law enforcement has wide latitude to purchase and request personal data from companies. They can obtain a court order about a particular crime and companies are obliged to provide information related to the crime, some companies have made special portals to more easily provide data. Even without a court order, law enforcement can purchase bulk data from data brokers about suspected crimes or general surveillance. These data can contain location information, internet searches queries, among other personal information. Companies can push back but with a court order or subpoena are obliged to comply with law enforcement.
Surveillance of this nature has historically enjoyed wide support as protection against terrorism and other societal harms. But the combination of prolific personal data collection and law enforcement surveillance are predicated on the assurance that data about everyday interactions and behaviors are not under scrutiny by law enforcement. The overturning of Roe v. Wade calls this trust into question.
The Progressive Policy Institute (PPI) released the following statement on the Inflation Reduction Act of 2022:
“PPI applauds Senator Joe Manchin and Majority Leader Chuck Schumer for returning to the negotiating table and agreeing on a historic reconciliation bill that would invest in clean energy, lower the cost of health care, and modestly reduce federal budget deficits. This bill advances precisely the kind of pro-growth, innovative climate policy that PPI has been calling for throughout the process and that America needs. It will not only spur new investments, create jobs, reduce emissions, and critically lower the cost of living for millions of Americans, but also strengthen our country’s economic future for generations to come.
“This deal is a major step forward for Congressional Democrats and the American people, and while it does not include as many legislative priorities as the original framework, PPI is encouraged to see a few well-funded programs that will result in transformational change rather than a broad progressive wish list. We are also encouraged that the deal includes a plan for taking up additional legislation to reform federal permitting processes later this year, which has long been a PPI priority.
“This package isn’t perfect. It doesn’t close the Medicaid coverage gap, or permanently fix the ACA subsidy cliff. More deficit reduction would have strengthened the legislation’s inflation-fighting potential. But the perfect cannot be the enemy of the good, especially when Democrats have an ideologically diverse caucus with no votes to spare in the Senate. Democrats should take the win now and continue to work on making further progress in these areas next Congress.
“Together with the CHIPS and Science Act and the bipartisan infrastructure law, the Inflation Reduction Act of 2022 will cement President Biden’s legacy of the largest increase in domestic public investment in modern history. Democrats in both chambers should act quickly and decisively to advance these bills and secure a stronger future for all Americans.”
The Progressive Policy Institute (PPI) is a catalyst for policy innovation and political reform based in Washington, D.C. Its mission is to create radically pragmatic ideas for moving America beyond ideological and partisan deadlock. Learn more about PPI by visiting progressivepolicy.org.
Monkeypox virus has long been endemic — meaning there is a continuous baseline level of infection — in West and Central Africa. But nine weeks ago, the virus left the continent and began spreading in Europe and now the U.S. There are now at least 13,000 cases across 60 countries and three reported deaths. In the U.S. alone there are almost 2,300 cases and unfortunately, it seems that the public health infrastructure and the Centers for Disease Control and Prevention (CDC) are demonstrating some the same pitfalls of the early days of COVID. Experts say that the window to contain the disease is closing.
The monkeypox virus presents itself with fever, body aches, chills, and fatigue, and if it is a more severe infection, rashes, and lesions. It spreads person-to-person through direct contact with the rash, respiratory droplets, and through touching contaminated clothing or linens. It has a long infectious period of roughly 2-4 weeks. Though the symptoms can resolve themselves, it can be highly uncomfortable and is a greater threat to immunocompromised people, children, and pregnant women. There have been no reported deaths outside of Africa but right on the heels of a multiyear, deadly, global pandemic, how is the U.S. repeating several of the same errors as it did during the early days of COVID?
Too little testing: Until recently, monkeypox testing was limited to a small number of government-run labs that are a part of the CDC’s Laboratory Response Network. This meant that providers were required to complete bureaucratic paperwork to receive permission to order a test. This slowed testing in the initial days of the outbreak. However, in recent days, five commercial labs have begun offering monkeypox testing which should help alleviate testing backlogs. Unfortunately, it may be too late to stop the virus from spreading: the virus is already spreading undetected in many communities as indicated by exceptionally high positivity rates — the rate at which those who are tested are positive. And for many of the confirmed cases, health officials don’t know how the person caught the virus. Those infected haven’t traveled or knowingly been in contact with another infected person.
Not enough vaccines: Unlike the onset of the COVID-19 pandemic, there are two vaccines that are effective (roughly 85% efficacy) at preventing monkeypox. First, there is an older smallpox vaccine which also works against the virus — however, it has a high risk of side effects and can’t be used on people who have HIV or are pregnant. Then there is a newer smallpox vaccine that also works on monkeypox, without the risks of the older vaccine. Though the U.S. has ordered nearly 7 million doses, it has struggled to expedite the acquisition and distribution process. In fact, 1 million doses that have already been purchased have been held up in a manufacturing facility in Denmark awaiting on FDA clearance. The CDC estimates that roughly 1.5 million American men are eligible for the vaccine based on their guidance.
As states and localities have received a slow drip of vaccines, appointments have been gobbled up faster than they can be set up. New York City, learning from lessons of COVID-19, has decided to give as many first doses as they can and worry about the follow up doses later. This goes against FDA guidance but is the type of response that is warranted in an emergency.
Limited access to treatments: An FDA approved smallpox antiviral drug, TPOXX, is presumed to work on monkeypox, but will require physicians to obtain special permission to use it on their monkeypox patients. The bureaucratic application process creates further delays in treating patients suffering from the symptoms of monkeypox: lesions, headaches and sometimes debilitating pain.
It’s important to note that this virus isn’t COVID-19. It’s not a novel, deadly virus without treatments or vaccines. There is no need for widespread masking or shutdowns. Indeed, the United States government has been forward looking enough to order monkeypox/smallpox vaccines and stockpile treatments, but now that the virus has presented itself, the government can’t seem to efficiently deliver on the last mile of getting the therapeutics to patients.
COVID-19 and monkeypox illustrate that the threat of diseases is ongoing — pathogens will continue to emerge and pose a threat to the public. It’s paramount that the U.S. invest in the pandemic preparedness infrastructure to meet demand as I outlined in an earlier paper. It’s time for the government to learn from its missteps and invest in the public health system, such as on the ground clinics, as well as supply chain infrastructure, and to embrace greater flexibility when combating novel threats.
The Progressive Policy Institute (PPI) released a new paper today arguing United States policymakers should consider more aggressive ways to obtain health care pricing information from hospitals, which could effectively boost price transparency for patients. The paper is titled,“Rethinking health insurance: Can price transparency and cash pay help consumers?” and is authored by Arielle Kane, Director of Health Care for the Progressive Policy Institute.
“For price transparency rules to work, they need to be enforced,” writes report author Arielle Kane. “When people have a serious accident or medical emergency, they aren’t inclined to comparison price shop. But most medical visits are for less than urgent care. When people do have time and inclination to compare prices, they should be able to do so. And allowing researchers and journalists to review pricing data can help expose the predatory billing practices that some providers engage in. Public scrutiny could help the industry move toward ethical, and transparent, billing practices.”
Only 14% of hospitals are in compliance with a 2021 rule from U.S. Center for Medicare and Medicaid Services (CMS) requiring hospitals post the prices for 300 so-called “shoppable” services, online. This rule, which was intended to encourage competition between hospitals and provide price transparency for consumers, has limited enforcement mechanisms. As the next chapter of this rule goes into effect this week, requiring insurers to disclose the rates they pay hospitals, there is the potential to improve the shopping experience for consumers – but only if it is enforced.
Kane’s report reviews the history and status of the price transparency regulation and finds that greater enforcement is needed to achieve the full potential of price transparency. After reviewing cash-pay data from 14 of the 300 “shoppable” billing codes, PPI finds that on average, hospitals charge 120% of the commercial insurance rates to patients paying with cash. However, there is evidence to suggest that hospitals are inflating their publicly reported “cash-pay” rates.
The Progressive Policy Institute (PPI) is a catalyst for policy innovation and political reform based in Washington, D.C. Its mission is to create radically pragmatic ideas for moving America beyond ideological and partisan deadlock. Learn more about PPI by visiting progressivepolicy.org.
Democrats have been taking incremental steps toward universal health insurance coverage for nearly a century. The latest Affordable Care Act (ACA) subsidy expansions have pushed the U.S. closer to universal coverage than ever before. But skyrocketing health care costs — which makes coverage more expensive for individuals, employers, and the government — continue to hamstring the goal of universal coverage.
In 2021, the average premium for a family of four with employer-sponsored coverage was $22,221. In response to exponentially growing increases in premiums, employers have been shifting costs onto their workers, with the result that roughly half of those with employer-sponsored coverage now are enrolled in high-deductible health plans. The average deductible for a family plan in 2021 was $5,969. No wonder that Americans who don’t have coverage cite high costs as the reason.
U.S. policymakers would like to bring down these high out-of-pocket costs, but don’t have many policy levers to pull. However, in an effort encourage price competition between hospitals, in 2021, the U.S. Center for Medicare and Medicaid Services (CMS) began requiring hospitals post the prices for 300 so-called “shoppable” services, online. They are required disclose “standard charges, including the rates they negotiate with insurance companies and the discounted price a hospital is willing to accept directly from a patient if paid in cash … in a consumer-friendly display” so that patients can view them in advance. The idea is to help patients who haven’t hit their deductibles or don’t have full insurance coverage to shop around for care.
In reality though, only 14% of hospitals are in compliance with the regulation. The Biden administration has increased the maximum non-compliance penalty to $2 million per hospital. But even with the stiffened penalty, many hospitals have decided that with limited enforcement, the fine is worth the risk of non-compliance.
But if the rule were more effectively enforced, would price transparency alone really give consumers a break on their health care expenses? This report looks at how the price transparency rule could reduce health care costs through two mechanisms. First, will the price transparency regulation encourage competition between providers and reduce costs? And secondly, does posting the cash price for shoppable services reduce costs for patients?
This report reviews the status of the price transparency regulation and finds that greater enforcement is needed to achieve the full potential of price transparency. After reviewing cash-pay data from 14 of the 300 “shoppable” billing codes we find that on average, hospitals charge 120% of the commercial insurance rates to cash pay patients. However, there is evidence to suggest that hospitals are inflating their publicly reported cash-pay rates from the rates they charge cash-pay patients at the point of service.
Policymakers need to consider more aggressive ways of obtaining health care pricing information. For example, they could consider requiring all-payer claims databases and even adopting price caps if hospitals refuse to comply with price transparency rules.
